HomeMy WebLinkAbout20110318 Ver 1_Certification of Completion_20120705A ��
NCDENiR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Waklld P E
Governor Director
NCDWQ Protect No 2n1 10?) ($ County v4d6o l
Applicant KcmoT
ProlectName 13f'lJge *-3 on SR 1&3 - -MP No 13^g37-2
Date of Issuance of 401 Water Quality Certification
Dee Freeman
Secretary
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules and
any subsequent modifications the applicant is required to return this certificate to the 401 Transportation Permitting
Unit North Carolina Division of Water Quality 1650 Mail Service Center Raleigh NC 27699 1650 This form
may be returned to NCDWQ by the applicant the applicant s authorized agent or the project engineer it is not
necessary to send certificates from all of these
Applicant s Certification
I hereby state that to the best of my abilities due care and diligence
was used in the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules the approved plans and
specifications and other supporting materials
Signature
Agent's Certification
Date
I hereby state that, to the best of my abilities due care and diligence
was used in the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules the approved plans and
specifications and other supporting materials
Signature
Engineer s Certification
Date
Partial Final
�r'cH� Nla%..art as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically weekly full time) the construction of the project for the
Permittee hereby state that to the best of my abilities due care and diligence was used in the observation of the
construction such that the construction was observed to be built within substantial compliance and intent of the 401
Water Quality Certification and Buffer Rules the approved plans and specifications and other supporting materials
-, /�1G1-
Signature Registration No 0'37-1'47-
Date 1Z
Transportation and Permitting Unit
1650 Mad Service Center Raleigh North Carolina 27699 1617
Location 512 N Salisbury St Raleigh North Carolina 27604
Phone 919. 807 -63001 FAX 919 -807 -6492
Internet www ncwaterguality ora
An Equal Opportunity 1 Affirmative Action Employer
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